In CMS
Jul 13th, 2017
The Office of Inspector General’s (OIG) combat on healthcare fraud, waste, and abuse of taxpayer’s money recovers $5 for every $1 spent on investigating, which gives them incentive to target more areas of fraud. The OIG’s latest and largest fraud takedown happened this month when opioid fraud was exposed with the help of state and federal law ...
In Audit
Jul 13th, 2017
Think your healthcare covered entity doesn’t need to establish and maintain Business Associate Agreements (BAA) with companies who can access your patients’ protected health information (PHI)? Think again. Cases in Point March 2016 — North Memorial Health Care agreed to pay the U.S. Department of Health and Human Services (HHS) $1,550,000 to settle charges that it potentially ...
In Audit
Jul 10th, 2017
A Detroit-area medical biller was recently sentenced to 50 months in prison for helping with a $7.3 million Medicare and Medicaid fraud scheme where services were billed but not rendered. Dawn Bentley, 56, of Oakland County, Michigan, was also ordered to pay $3,253,107 in restitution with her co-defendants for one count of conspiracy to commit ...
Jul 6th, 2017
Charlotte-Mecklenburg Hospital Authority is paying the federal government $6.5 million to resolve allegations the company violated the False Claims Act, up-coding claims for urine drug tests. The group, owned by Carolina HealthCare System, submitted high complexity evaluation and management (E/M) codes for urine drug tests, which Medicare considers moderate complexity. The government alleged that t...
Jul 3rd, 2017
To be sure your providers and employees are following all rules and regulations to keep your medical practice compliant, you should create a compliance program. The Office of Inspector General lists seven core components for an effective compliance program. Implement standards through written policies and procedures Providers and employees need written policies or procedures to ...